Osman Nora Y, Walling Jessica L, Mitchell Vivian G, Alexander Erik K
a Department of Medicine , Brigham and Women's Hospital and Harvard Medical School , Boston , Massachusetts , USA.
Teach Learn Med. 2015;27(2):130-7. doi: 10.1080/10401334.2015.1011655.
PHENOMENON: Changes in the medical education milieu have led away from the apprenticeship model resulting in shorter physician-student interactions. Faculty and student feedback suggests that supervisor/student interactions may now be more cursory with increasing numbers of supervisors per student, and shorter duration of interaction. This may affect both education and student assessment.
We compared inpatient attending and resident daily schedules with those of 3rd- and 4th-year medical students rotating on medicine clerkships at Brigham and Women's Hospital during academic years 2009-11 to determine the number of days of overlap. We used evaluation forms to determine the extent of evaluator's self-reported knowledge of the student.
We correlated the daily schedules of 199 students and 204 resident and 187 attending physicians, which resulted in 558 resident-student pairings and 680 attending-student pairings over 2 years. During a 4-week block, students averaged 3.7 attending physicians (M = 4, range = 2-7), with 49.7% supervised by 4 or more. Attending-student overlap averaged 9 days (M = 9, range = 2-23), though 40% were 7 days or less. Students overlapped with an average 3.4 residents (M = 3, range = 1-6). Resident-student overlap averaged 12 days (M = 11, range = 3-26). There were 824 student assessment forms analyzed. Resident and attending physician supervisors describing knowledge of their student as "good/average" overlapped with students for 14 and 11 days respectively compared to resident and physician supervisors who described their knowledge as "poor" (11 days, p < .01; 6 days, p < .01). Insights: On the inpatient medicine clerkship, students have multiple supervising physicians with wide variability in the period of overlap. This leads to a disrupted apprenticeship model with fragmentation of supervision and concomitant effects on assessment, feedback, role modeling, and clerkship education.
现象：医学教育环境的变化使学徒制模式逐渐式微，导致医生与学生的互动时间缩短。教师和学生的反馈表明，随着每个学生的导师数量增加，导师与学生的互动可能变得更加草率，互动时间也更短。这可能会影响教育和学生评估。
我们将住院医生和住院医师的日常时间表与2009 - 2011学年在布莱根妇女医院进行内科实习的三、四年级医学生的时间表进行比较，以确定重叠天数。我们使用评估表来确定评估者自我报告的对学生的了解程度。
我们关联了199名学生、204名住院医师和187名主治医师的日常时间表，在两年内产生了558对住院医师 - 学生配对和680对主治医师 - 学生配对。在为期4周的时间段内，学生平均有3.7名主治医师（中位数 = 4，范围 = 2 - 7），其中49.7%由4名或更多的主治医师监督。主治医师与学生的重叠时间平均为9天（中位数 = 9，范围 = 2 - 23），不过40%的重叠时间为7天或更短。学生平均与3.4名住院医师重叠（中位数 = 3，范围 = 1 - 6）。住院医师与学生的重叠时间平均为12天（中位数 = 11，范围 = 3 - 26）。共分析了824份学生评估表。将学生知识评价为“良好/中等”的住院医师和主治医师导师与学生的重叠时间分别为14天和11天，而将学生知识评价为“差”的住院医师和主治医师导师与学生的重叠时间分别为11天（p < 0.01）和6天（p < 0.01）。见解：在内科实习中，学生有多名指导医师，重叠时间差异很大。这导致学徒制模式被打乱，监督碎片化，并对评估、反馈、榜样作用和实习教育产生相应影响。
